Usually in writing. BUT they will in most states ONLY reveal the MEDICAL to your doctor only! The reason is that us as not trained in the medical physicians training we are not capable to understand. As an advisor for 30yrs MANY clients would get upset at me! I would explain I don't fully agree but it's an industry uniform standard procedure. I usually gave an example of two types of heart murmur, we could worry ourself to have a heart attack and find out that we had the lesser type of murmur! There was NO GOOD WAY to tell a client of being declined!
Get StartedIf your insurance company has denied your claim, you should have been sent an Explanation of Benefits (EOB). Read this document carefully to determine the reason for the denial. Your insurer may simply be requesting more information about your claim. If so, gather the necessary information and resubmit your claim.If the EOB is not simply asking for additional information, then you should contact the insurance company either by phone or in writing regarding the denial of your claim. The address and phone number of the insurance company should be listed on the EOB. Be sure to include your account number and any other important information that might help with the processing of your claim.If you phone the insurance company, be sure to write down the name of the person you spoke with. This information is important for future communications with the insurer.After you have learned the reason(s) for the insurance company's denial of your claim, you should resubmit your claim, attaching additional information to address each of the insurance company's concerns.If the insurance company continues to deny your claim AND you think that they are wrong, then you can contact your State Insurance Department.
An insurance denial attorney will fight for you, should your claim be denied by your insurance carrier.
Yes. If the medical provider wants to challenge the denial then the medical provider must submit his request for reconsideration within a certain time limit. The bill-er would have to contact the insurance company to find out when the time limit ends and if the denied claim can be re-billed with special documentation.
Yes, false information on any application for insurance could result in the denial of all claims associated with that policy.
No, that wouldn't be a reason for claim denial. It may be a reason for them to investigate you for insurance fraud.
If you're having a problem with an insurance company, you need to report them to your state's insurance commission. In addition, you can go to your state's attorney general for relief.
Yes, there are many. One attorney that specializes in insurance denial claims is Ralph R Hruby.
Yes, a judicial review can be requested if a denial of reconsideration is implemented. The court must be petitioned within 30 days of an EEOC denial of reconsideration.
The denial of the insurgent's request resulted in the massacre of the hostages.
Currently (2013) the rules with regard to patient pre-existing conditions are only regulated by the specific insurance company. In 2014 the ACA will make denial of coverage based on pre-existing conditions illegal. For more information speak with your insurer and see the related link.
The right to appeal and Procedures for appealing the denial
Get StartedWhen a managed care organization (such as a HMO) or an insurance company denies part or all of your claim, you should receive an explanation for the denial. This notice should contain the address and phone number of who you can contact with questions. Additionally, your general policy or benefits information should provide information on what to do in the case of a denial.